The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

Abstract

Background/Aims: Whether single large hepatocellular carcinoma (SLHCC) is classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B is still controversial. We aimed to compare the clinical manifestations, treatment modalities, and prognoses among patients with SLHCC and those in BCLC stage A and B. Methods: We enrolled 2,285 treatment-naive hepatocellular carcinoma (HCC) patients with BCLC stage A or B from October 2007 to December 2015. Factors in terms of prognoses were analyzed by multivariate analysis. Results: We enrolled 1,210, 466, and 609 patients in a BCLC-A, SLHCC, and BCLC-B group, respectively. After a median follow-up duration of 21.2 months, 898 patients had died. The cumulative 5-year survival rates were 57.0, 42.6, and 27.3% for patients in the BCLC-A, SLHCC, and BCLC-B groups, respectively, which were significantly different (p < 0.001). Multivariate analysis indicated that the following independent risk factors were associated with poor prognosis: age > 65 years, alkaline phosphatase > 100 U/L, creatinine > 1.0 mg/dL, alpha-fetoprotein > 20 mg/mL, noncurative treatment, albumin-bilirubin (ALBI) grade, and HCC staging. Subgroup analysis also confirmed that patients in the SLHCC group had a survival rate intermediate to those in the BCLC-A and BCLC-B groups. However, for patients in the SLHCC group and with ALBI grade 1, outcomes were close to those in the BCLC-A group, especially in the setting of curative treatment. For those with ALBI grades 2 or 3, the prognoses were similar to those of the SLHCC and BCLC-B groups. Conclusion: Patients in the SLHCC group had an overall survival rate intermediate to those of the BCLC-A and BCLC-B groups. It is suggested that the SLHCC group could be classified as occupying a different stage from the BCLC stages A and B. The ALBI grade could help to stratify SLHCC into a different prognostic group. However, the results need to be validated externally in other regions of the world.

Prognostic value of the ALBI grade among patients with single hepatocellular carcinoma without macrovascular invasion

“…The disease outcomes of HCC patients post-liver resection is partly affected by the existing liver physiological status. In accordance with previous studies 10,11,25,26 , we determined that ALBI grade could in uence the OS of the total cohort and tumor size ≤7 cm subgroup. The patients who had an ALBI grade 1 presented a better survival time compared to those had an ALBI grade 2 in the total cohort.…”

“…We observed that patients whose tumors were > 7 cm presented a lower albumin level, greater blood loss, and a higher proportion of serum AFP ≥ 400 ng/ml and poor differentiation than patients with tumor size ≤ 7 cm. AFP is regarded as an important prognostic indicator for HCC undergoing liver resection 18,21 . A high level of preoperative AFP often indicates poor survival time after surgery 22 .…”

Preoperative albumin-bilirubin grade combined with aspartate aminotransferase-to-platelet count ratio index predict outcomes of patients with hepatocellular carcinoma within Milan criteria after liver resection

“…ALBI score = (log10 bilirubin × 0.66) + (albumin × −0.085). ALBI grades were defined as grade 1 (score ≤ -2.60), grade 2 (score > -2.60 and ≤ -1.39), and grade 3 (score > -1.39) (12). APRI was calculated as [(AST value/ULN)/platelet count (10 9 /L)] × 100 (13).…”

Reply

“…(2) In contrast, a recent case-control study using the Taiwan National Health Insurance Research Database conducted by Shao et al reported that proton pump inhibitor use might increase the risk of hepatocellular carcinoma in patients without hepatitis B infection or hepatitis C infection (odds ratio, 2.86; 95% confidence interval, 2.69-3.04). (3) Because of conflicting results in these observational studies, some points should be discussed. First, at least 90% of patients with hepatocellular carcinoma in Taiwan are associated with chronic hepatitis B infection or chronic hepatitis C infection.…”

“…Because the majority (>80%) of HCC patients in Taiwan and East Asia have an active ongoing or resolved viral hepatitis, our study might provide more clinical implications for patients who bear a higher risk of developing HCC. (3) Regarding the nonviral etiology of HCC, Lai conducted a cohort study using the Taiwan NHI database, and it showed that incidences of HCC were similar between PPI users and non-PPI users after excluding alcohol-related disease, cirrhosis, hepatitis B infection, hepatitis C infection, other chronic hepatitis, and diabetes mellitus. (4) Furthermore, another recent meta-analysis of five observational studies demonstrated that PPI use was not associated with an increased risk of HCC.…”